Do you really need antidepressants?

Researchers at Emory University have discovered a brain scan that can predict whether medication or Cognitive Behavior Therapy (CBT) is the best for each person’s depression. At present the treatment plan is often based on the doctor’s or patient’s preference, but only 35-40% of people see any improvement with their first choice of treatment. It’s basically been trial and error.

But Dr. Helen Mayberg and her team of researchers used PET scans to measure brain glucose metabolism in the interior insula region of the brain, and found that scan patterns prior to treatment can provide important clues as to which treatment will be best. Patients with low activity in the anterior insula showed remission with CBT, but poor response to medication, while patients with high activity in the insula did well with medication and poorly with CBT.

Until now brain-imaging has been primarily a research tool, but the National Institute of Mental Health director Dr. Thomas Insel believes that “these results demonstrate how it may be on the cusp of aiding in clinical decision-making.”

Speaking personally, I’ve never seen a medication-only approach work in the long-term. I have seen medication work well in treating moderate to severe depression, but only when combined with counseling and lifestyle changes (e.g. diet, sleep, exercise, relaxation, Christian fellowship, etc.). However, this research might help explain why antidepressants just don’t seem to work at all for a large number of people.

If the success or otherwise of anti-depressants can be predicted, then that should build confidence in some cases and avoid weeks of frustrating and futile experimentation in others.